Active NPI
Lisa Malloy, R.D.
- Registered Dietitian
- Walsenburg, CO
National Provider Identifier
1962537522
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 810059
- Practice address
- 23500 US Highway 160
Spanish Peaks Regional Health Center
Walsenburg, CO 81089-9524 - Phone
- (719) 738-5100
- Fax
- (719) 738-5138
- NPI assigned
- Feb 23, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 810059 | CO | Primary |
Addresses
Primary practice location
23500 US Highway 160
Spanish Peaks Regional Health Center
Walsenburg, CO 81089-9524
Mailing address
23500 US Highway 160
Spanish Peaks Regional Health Center
Walsenburg, CO 81089-9524
Phone (719) 738-5100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 810059 | CO | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1962537522",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23500 US HIGHWAY 160",
"address_2": "SPANISH PEAKS REGIONAL HEALTH CENTER",
"city": "WALSENBURG",
"state": "CO",
"postal_code": "810899524",
"telephone_number": "719-738-5100",
"fax_number": "719-738-5138"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23500 US HIGHWAY 160",
"address_2": "SPANISH PEAKS REGIONAL HEALTH CENTER",
"city": "WALSENBURG",
"state": "CO",
"postal_code": "810899524",
"telephone_number": "719-738-5100",
"fax_number": "719-738-5138"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLOY",
"first_name": "LISA",
"name_prefix": "Ms.",
"credential": "R.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CO",
"license": "810059",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Walsenburg, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.